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Dr Sonal
- Dec 11, 2023
- 11 min read

Dental Amalgam Fillings: NHS Dentistry Hot Topics - The Ultimate Guide

Updated: Jan 22

Introduction

In the ever-evolving world of UK dentistry, there is currently a dental amalgam phase-out in the UK. As a UK dentist with years of experience, I've seen firsthand the shift in practices and policies surrounding dental amalgams which forms an important NHS dentistry hot topic for you to learn about.

This change is not just a procedural update; it's a pivotal movement reshaping the landscape of dental care. For aspiring dental professionals, understanding this transition is crucial.

This is a fundamental dentistry hot topic that you need to know about for your dentistry interviews for UK dental schools. All of these dentistry hot topics are ones that you can hopefully learn from during your dentistry work experience and can sometimes mention one or two on your personal statement.

It reflects not only on the current trends in UK dentistry but also on the future of dental treatments and patient care.

This guide aims to demystify the phase-out process, its implications, and its significance for future dental students, helping them navigate this important topic effectively to help smash your dentistry interviews and can form some part of your preparation when looking through dentistry interview questions.

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dental amalgam phase-out, mercury in dentistry, UK dental trends, amalgam fillings, Minamata Convention, mercury-free dentistry, composite resins, glass ionomer cement, dental amalgam regulations, dental amalgam alternatives, environmental impact of amalgam, health risks of dental amalgam, sustainable dentistry practices, dental amalgam disposal, dental school interview topics.

Dental Amalgams Summary:

Transition: The dental amalgam phase-out in UK dentistry marks a significant shift, with a focus on adapting practices and policies to newer, safer materials.
Materials: Dental amalgam, historically used for its durability and ease of application, is composed of mercury, silver, tin, and copper, but environmental and health concerns have driven its phase-out.
Alternatives: The move away from amalgam has led to the adoption of mercury-free alternatives like composite resins and glass ionomer cement, recognised for their aesthetic appeal and health benefits.
Regulations: The Minamata Convention plays a key role in this transition, influencing UK dental policies towards reduced amalgam use, especially among vulnerable populations.
Education: This change impacts current dental practices and shapes dental education in the UK, emphasising mercury-free materials and a focus on preventive care.

Latest Update [January 2024]

The European Parliament has voted (on 17/1/2024) to ban dental amalgam from January 1, 2025, impacting UK dental services.

This decision, aimed at phasing out the use of dental amalgam (silver amalgam), comes five years earlier than anticipated.

The British Dental Association (BDA) has expressed concerns about the potential adverse effects on UK dental practices, particularly in Northern Ireland, which must adhere to EU regulations post-Brexit.

The BDA is calling for collaborative efforts to manage the transition, focus on preventive measures, secure amalgam supplies, and mitigate financial impacts on dentists due to alternative material use.

As a result of Brexit, whilst this only directly affects Northern Ireland, this is likely to indirectly affect the rest of the UK through higher costs given the impact on supply chains, but not a formal ban.

Dental Amalgam Fillings: What Are They?

Dental amalgam is a filling material used since the 19th century and is often referred to as ‘silver fillings’ by the public. Known for its durability and strength, it is used to fill cavities, restoring dental health for millions.

It's a unique blend of metals, primarily composed of mercury mixed with silver, tin, and copper. This combination creates a hard, durable material ideal for dental fillings.

Historically, amalgam fillings have been the standard in UK dentistry.

The American Dental Association recognises dental amalgam as a safe, reliable, and affordable option for dental restoration, despite ongoing debates regarding health risks associated with mercury exposure.

Mercury, in the form of elemental mercury, is a key component of dental amalgam, and its use has raised concerns about mercury vapour release and potential allergy to mercury.

However, studies like the New England Children's Amalgam Trial have demonstrated that the amount of mercury in dental amalgam is low and typically does not lead to significant health issues.

The use of dental amalgam is often favoured for its longevity compared to alternatives like composite resin, involves a careful amalgam alloy preparation, which includes silver and other metals.

Nonetheless, interest in amalgam alternatives is growing, partly due to aesthetic preferences and concerns about mercury from dental amalgam.

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Pros of Dental Amalgams

Their popularity stems from several key advantages and pros of using dental amalgams:

Durability: Due to its composition, dental amalgam can withstand liquids, harsh chewing forces and pressure making it an excellent choice for fillings for teeth in the back of your mouth (molars).
Longevity: These fillings often last decades, offering a long-term solution for tooth decay. This means there is less chance of it fracturing and needing replacements
Ease of Use: Unlike other restorations, amalgam is easy to use in most dental situations. It is less moisture-sensitive than composite resins making it work well in areas of the mouth that are difficult to keep dry

Despite these benefits, the tide has turned against dental amalgam, driven by environmental and health considerations.

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Cons of Dental Amalgams: Environmental and Health Implications -

The phase-out of dental amalgams in the UK isn't a decision taken lightly. It's rooted in significant environmental and health concerns. As a material containing mercury, dental amalgam poses environmental risks that extend beyond the dental chair:

Environmental Impact: When amalgam waste enters water systems, mercury pollution becomes a real threat. It's a concern I've become increasingly aware of in my practice. This pollution affects aquatic life and can enter the human food chain, posing broader ecological risks.
Health Risks: While amalgam fillings are generally considered safe, concerns remain for certain populations. Pregnant women, children, and those with specific health conditions might be more susceptible to mercury's potential effects.
Aesthetic Concerns: Amalgam fillings are silver in colour and can darken over time. They are more noticeable than tooth-coloured materials like composite resins, which can be a cosmetic concern for fillings in visible areas.
Possible Allergic Reactions: A small percentage of people are allergic to mercury or other metals in dental amalgams, such as silver, tin, or copper. This can lead to local reactions in the mouth or other allergy symptoms.
More invasive: The placement of amalgam fillings can require more removal of the tooth structure compared to other types of fillings, potentially weakening the remaining tooth.

This growing awareness has propelled the dental community, including myself, towards safer, more sustainable practices.

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Why is mercury used in dental amalgams?

Mercury is a key component used in dental amalgam due to its useful properties that enhance the functionality of the filling.

It allows the amalgam to be manipulated into a soft, pliable form when mixed with other metals, such as silver, tin, and copper, creating a compound that can be easily inserted and shaped into a tooth cavity.

Once placed, the mercury causes the mixture to harden quickly and securely, helping restore the tooth’s structure.

Furthermore, mercury-enhanced amalgam is durable, resistant to wear and tear, and less likely to break compared to other filling materials. Thus, mercury has played a crucial role in ensuring the efficiency of dental fillings.

The Minamata Convention and UK Regulations

The Minamata Convention is an international legally binding treaty that aims to protect the environment and human health from the negative effects of mercury and its compounds. The discussion involves dental amalgam’s phasing out towards preventative and minimally invasive dentistry using restorations such as composite resins.

What do the new UK and EU regulations recommend for the use of amalgam in dentistry?

To help reduce the use of dental amalgam, reduce global environmental pollution caused by mercury and reduce the amount of disposal of mercury products it has been advised against using dental amalgam in:

Children under 15 years old, unless dentists find it necessary
Baby/ milk teeth
Pregnant ladies
Those breastfeeding

Transitioning to mercury-free dentistry is more than regulatory compliance. It's a step towards a more sustainable, health-conscious dental practice.

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Understanding England's National Plan to Phase Down Dental Amalgam Fillings

England's National Plan to phase down the use of dental amalgam, instigated in response to EU Regulation 2017/852 on Mercury, outlines a comprehensive approach targeting the reduction of amalgam use in dentistry.

The plan is specific to England, acknowledging the devolution of health matters within the UK.

Key aspects of the plan include:

Adoption of Minimal Intervention Dentistry: This approach emphasises preserving tooth structure and utilising non-amalgam materials like composites and glass ionomers, promoting this both in undergraduate and continuing dental education.
Oral Health Improvement Initiatives: Targeting a reduction in dental decay, especially among children and vulnerable groups, these initiatives aim to lessen the overall need for fillings.
Reforming Dental Care Practice: The plan introduces a trial in the NHS dental primary care system focusing on preventive care to reduce decay prevalence.
Restricted use in children under 15 and pregnant women, those breastfeeding and on milk teeth
Significant improvements in oral health over the past 40 years, as indicated by national surveys, support this transition. Public Health England (PHE) has been pivotal in this, establishing groups dedicated to improving oral health in children and adults and publishing guides like ‘Delivering Better Oral Health’.

Looking ahead, the government plans to continue its focus on preventive dental care, aligning with a broader health strategy that emphasises prevention.

In summary, the National Plan to phase down dental amalgam in England represents a significant step in transforming dental care practices, moving away from traditional methods towards a more preventive, health-oriented approach.

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Alternatives to Dental Amalgams

With the phase-out of dental amalgams in the UK, the focus shifts to alternative materials. These alternatives not only address environmental and health concerns but also align with modern dental advancements.

As a dentist, I've embraced these changes, recognising the benefits they bring to patient care.

Here are the key alternatives:

Composite Resins: These tooth-coloured materials have gained popularity for their aesthetic appeal. They blend seamlessly with the natural tooth, a feature highly appreciated by patients. Although they are the most moisture-sensitive fillings, when placed correctly they work well. Unlike dental amalgam restorations, composite restorations bond to the teeth meaning the tooth can require less drilling, hence more minimally invasive and better for the tooth
Glass Ionomer Cement: Although they are not as strong as dental amalgams, they are ideal for small fillings, this material releases fluoride, offering added benefits for dental health.
Ceramic Fillings: Known for their durability and aesthetic quality, ceramics are a preferred choice for visible areas.

Each alternative comes with its advantages, from aesthetic appeal to biocompatibility.

In my practice, the shift towards these materials has been well-received, marking a step forward in patient-focused care.

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The Impact of Dental Amalgam Changes on Dental Practices and Education

The dental amalgam phase-out is not just changing dental practices but also reshaping dental education in the UK. As a dental professional, I've witnessed these shifts firsthand:

Updated Curriculum: Dental schools are now emphasising the use of mercury-free materials, preparing students for modern practices.
New Skill Sets: The application of alternatives like composite resins requires different techniques, a change that both challenges and excites future dentists.
Focus on Sustainability: There's a growing emphasis on environmentally friendly practices in dental education, reflecting a global shift towards sustainability.

This evolution in dental practices and education is crucial. It ensures that new dentists are not only skilled but also aligned with contemporary environmental and health standards.

Example Dental Amalgam Dentistry Interview Questions

For students preparing for dental school interviews, understanding the dental amalgam phase-out is key.

Here are some example questions that might come up, reflecting the depth and breadth of this topic (but are probably too specific compared to ones that may come up):

What is the composition and historical use of dental amalgam in UK dentistry?
How does the dental amalgam phase-out reflect current UK dentistry trends?
Discuss the environmental impact of dental amalgam, specifically regarding mercury pollution.
What are the health risks associated with dental amalgam, especially in vulnerable demographics?
How does the Minamata Convention influence dentistry policies related to amalgam use in the UK?
Compare the durability and cost-effectiveness of amalgam fillings versus composite resins.
What are the sustainable dentistry practices being adopted in the UK in light of the amalgam phase-out?
Explain the role of mercury-free dentistry in the UK's future dental care landscape.
How is the dental amalgam controversy affecting patient choices and dental practices in the UK?
What are the implications of the dental amalgam phase-out for dental education and training in the UK?
Discuss the advancements in dental care materials as alternatives to dental amalgam.
How are new dental technologies shaping the future of dental restorative materials post-amalgam?
What guidelines should UK dental practices follow for the safe disposal of dental amalgam?
How does the dental amalgam phase-out align with global environmental and health standards?
What are the key considerations for UK dental students in understanding the shift away from dental amalgam?

Ensure that you read about dental amalgams to help answer more questions on them from your dentistry interview in the UK.

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FAQs on Dental Amalgam Phase-Out

1. What is dental amalgam made of?

Dental amalgam is a mixture of metals, primarily comprising mercury, silver, tin, and copper. Mercury, which makes up about 50% of the compound, binds these metals into a durable material used for fillings.

2. Why is mercury used in amalgam, and what are the risks?

Mercury is used in amalgam for its unique ability to bind metal alloys into a hard, durable filling material. However, concerns about mercury include environmental pollution and potential health risks, particularly for vulnerable populations such as pregnant women and children.

3. How are dental practices adapting to the phase-out?

Dental practices are adapting by transitioning to mercury-free alternatives like composite resins and glass ionomer cement. They are also updating their waste management practices to ensure safe disposal of amalgam.

4. What should patients know about amalgam removal?

Patients should understand that amalgam removal must be done carefully to minimise exposure to mercury vapour. Dentists use specific protocols and equipment to ensure safe removal and disposal.

5. How does the phase-out affect future dental treatments?

The phase-out is leading to increased use of alternative materials that are more aesthetically pleasing and environmentally friendly. It's driving innovation in dental materials and treatment techniques.

6. What are the alternatives to dental amalgam for fillings?

Alternatives include composite resins, which are tooth-coloured and blend with natural teeth, and glass ionomer cement, known for its fluoride-releasing properties and good adhesion.

7. Is it safe to have amalgam fillings during pregnancy?

Current guidelines recommend avoiding amalgam fillings during pregnancy due to the potential risk of mercury exposure. Alternative materials are preferred during this time.

8. How does dental amalgam contribute to environmental mercury pollution?

Amalgam contributes to environmental mercury pollution mainly through dental clinic waste and cremation of remains with amalgam fillings. This mercury can accumulate in water bodies, affecting aquatic life.

9. Are amalgam fillings still being used in the UK?

While their use is declining, amalgam fillings are still used in certain cases, particularly when moisture control is challenging or when alternative materials are not suitable.

10. How long do dental amalgam fillings last compared to alternatives?

Amalgam fillings can last about 10-15 years, often longer than some alternatives. However, materials like composite resins have improved significantly and offer comparable longevity.

11. What is the Minamata Convention, and how does it affect dentistry?

The Minamata Convention is an international treaty aimed at reducing mercury pollution. In dentistry, it has led to the phase-out of dental amalgam to minimise mercury use and release into the environment.

12. Can existing amalgam fillings increase mercury levels in the body?

While amalgam fillings can release low levels of mercury vapour, studies suggest that these levels are typically below those associated with health risks for most people.

13. What are the guidelines for the safe disposal of dental amalgam?

Guidelines include using amalgam separators in dental clinics, following specific waste disposal protocols, and ensuring amalgam waste is not released into the general waste stream or water systems.

14. What should dental students know about amalgam in preparation for their interviews?

Dental students should be aware of the composition, historical use, reasons for the phase-out, and alternatives to amalgam. They should also understand the environmental and health implications.

15. How is patient perception influencing the shift away from dental amalgam?

Patient preference for more aesthetic, mercury-free fillings is a significant driver in the shift away from amalgam. Increasing awareness of environmental and health issues also plays a role.